Complaint Investigation Report

Staff did not prevent a client from hitting another client.

It was alleged that staff did not prevent client #1 (C1), from hitting Client #2 (C2) and that supervision was inadequate. To investigate, LPA interviewed the Program Director (PD), Human Resources Director (HRD), two (2) Instructors, Activities Coordinator (AC), and nine (9) clients present during the incident, and reviewed C1's Individual Program Plan (IPP) and incident reports. The PD stated that staff maintain a 6:1 client-to-staff ratio, are trained in verbal redirection, de-escalation, and CPI techniques, and supervise clients at all times. C1 has a history of physical aggression, and staff are familiar with behavioral tendencies and verbal redirection.

HRD and the Instructors stated that the incident occurred suddenly when C1 turned off the lights during an advocacy meeting. The Instructor attempted verbal redirection; C1 struck the Instructor and subsequently C2. Staff intervened immediately, and AC removed C1 from the area. All clients reported staff were present, intervened, and ensured safety. During observations, LPA noted staff were actively supervising clients. Incident reports confirmed immediate staff response, removal of C1, and no injuries.

Based on interviews, record review, and observations, the allegation that staff failed to supervise C1 or prevent client-to-client aggression is Unsubstantiated .

Appeal rights explained and exit interview conducted.

Copy of this report signed and delivered.